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^ Asia Pacific 
>mmunity of Practice 
on HIV, Gender and 
Human Rights 



. 




«* 






Sumra 



lIHW 



:ussion on 



mj Linkages between Violence-Against- 
Women and HIV in Asia and the Pacific 



25 November to 1 December • 201 2 



a partnership initiative with 



UNITED NATIONS 
HUMAN RIGHTS 




The Asia Pacific Community of Practice on HIV, Gender, and Human Rights [HIV-APCoP] 

is an interactive and dynamic knowledge network jointly established by UNDP, UNAIDS, UN 
Women, UNOHCHR, and APN+ in response to the challenges faced by the Asia Pacific countries 
on HIV, gender, and human rights.The HIV-APCoP is supported by the Asia-Pacific UN Interagency 
TaskTeam on Women, Girls, Gender Equality and HIV. 

This network is open to a broad range of actors working on these issues, including all relevant 
UN family partners, networks of people living with HIV, national and local governments, key civil 
society organizations, and academic and research institutions. 



This publication has been prepared by the UNDP Asia-Pacific Regional Centre on behalf of UNDP, 
UNAIDS, UN Women, OHCHR and APN+. 

Design: Ian Mungall. Photos: Teeka Bhattarai/UNDP (cover page). 



Introduction 

From 25 November to 1 December 201 2 the Asia Pacific Community of Practice 
on HIV, Gender and Human Rights (HIV-APCoP) held an e-discussion on linkages 
between violence-against-women (VAW) and HIV, coinciding with the 16 Days 
of Activism on violence-against-women 1 . The e-discussion was conducted to 
engage with the HIV-APCoP's diverse membership of UN agencies, networks of 
people living with HIV, national and local governments, civil society organizations 
and academic and research institutions, to inform a Discussion Paper on HIV 
and violence-against-women 2 that has been commissioned by the Asia-Pacific 
United Nations Interagency Task Team on Women, Girls, Gender Equality and 
HIV (IATT). A survey was conducted in early July 201 2 prior to the e-discussion to 
collect inputs on available research, policies and programmes on VAW and HIV 
and sought to identify the major gaps in evidence, policies and programmes. 

The e-discussion sought inputs from the diverse membership of the HIV-APCoP 
to identify: 

□ Members views on the linkages between violence-against-women and HIV 
in the Asia-Pacific region; and 

□ Practical ways of addressing the intersection of violence-against-women 
and HIV 

Over 30 members participated in the survey and online discussion. The 
contributions were insightful and of strong quality. Activity on the website 
indicated widespread reach of content of the discussion. Over the duration of 
the e-discussion the HIV-APCoP website received visits from 143 different users 
from 36 countries, including from 19 countries in the Asia Pacific region. In 
addition, every contribution to the e-discussion was disseminated via email to 
the HIV-APCoP's 500+ members. 

The HIV-APCoP would like to extend a special thanks to guest moderator Ms. 
Neelanjana Mukhia, founding member of the international 'Women Won't Wait 
Campaign 7 on the intersection of violence-against-women and HIV. 



1 For more information visit http://saynotoviolence.org/join-say-no/201 2-1 6-days-activism-against- 
gender-violence-campaign 

2 The Discussion Paper is expected to be published in mid 201 3. 



■ I Despite a robust 
global policy framework, 
limited evidence from 
the region illustrating the 
nature of the linkages 
between violence-against- 
women and HIV (both 
explicit and implicit) 
continues to undermine 
efforts to address the 
twin epidemics through 
effective, evidence- 
based programmatic 
interventions. 

NEELANJANA MUKHIA, 
GUEST MODERATOR 



Message from Neelanjana Mukhia, Guest Moderator 

Neelanjana Mukhia is a founding member of the international campaign on the 
intersection of violence against women and HIV Women Won't Wait Campaign', 
and managed the international secretariat of the campaign since its inception up to 
late 2010. She has been working on women's rights and gender equality issues for 15 
years in South Asia and internationally including in Africa, and has published widely 
on issues relating to women's empowerment and gender equality 

I am delighted to launch this e-discussion on violence-against-women and HIV 
on the first day of the 1 6 Days of Activism on Violence against Women. 

Violence-against-women is an egregious violation of women's human rights 
and at the same time is a manifestation of and instrument to maintain women's 
subordination. According to the UN Secretary General's report 3 , violence against 
women maintains "control over women's sexuality and reproductive capacity 
and exploitation of women's productive and reproductive work." All women 
may be at risk of violence; however, it is critical to acknowledge the power and 
privilege imbalances that exist amongst different groups of women which can 
further exacerbate risk of violence as well as inhibit access to justice. The risk of 
violence can increase significantly for women who face multiple and intersecting 
discriminations 4 on the basis of their class, caste, race, age, ethnicity, sexual 
orientation, gender identity, etc. In the context of HIV, this includes women who 
face multiple discriminations, often sanctioned by the state, on the basis of their 
HIV status (women living with HIV), work (sex workers) and addiction (women 
who inject drugs). 

Despite a robust global policy framework, limited evidence from the region 
illustrating the nature of the linkages between violence-against-women and HIV 
(both explicit and implicit) continues to undermine efforts to address the twin 
epidemics through effective, evidence-based programmatic interventions. 

The Asia-Pacific UN Interagency Task Team on Women, Girls, Gender Equality 
and HIV(IATT) has commissioned a discussion paper reviewing the evidence of 
the linkages between violence-against-women and HIV, contextually specific to 
the Asia Pacific region. The paper will collate information available on the inter- 
linkages in the region and help develop a common position on the issue. 



3 In-depth study on all forms of violence against women, Report of the Secretary-General, 2006, 
http://www.un.org/womenwatch/daw/vaw/SGstudyvaw.htm 

4 The Declaration on the Elimination of Violence Against Women (UN General Assembly, 1 993) ac- 
knowledges the fact that particular groups of women are especially prone to be targeted for violence, 
including minority, indigenous and refugee women, destitute women, women in institutions or in 
detention, girls, women with disabilities, older women and women in situations of armed conflict. 



www.hivapcop.org 



The research has identified the following evidence in the Asia Pacific region: 

Violence as a risk factor for HIV 5 

□ In Asia Pacific most studies exploring the relationship between violence- 
against-women and HIV have been limited to India. 

□ A study with husband-wife dyads in India found that abusive husbands 
were more likely to acquire HIV than non-abusive husbands and the HIV 
risk for women in violent relationships was seven times greater than 
that of women not in violent relationships 6 . 

HIV as a risk factor for violence 

□ Few studies show prevalence of intimate partner violence among women 
living with HIV. 

□ One study in rural and urban India found that women living with HIV 
were more likely to report forced sex and domestic violence than 
women who were not HIV positive. Another study, also from India, 
found that 42 percent of women visiting voluntary counseling and 
testing for HIV centers who tested positive reported intimate partner 
violence. Of these, 18 percent believed the cause of violence was their 
status. 78 

Violence against sex workers 9 

□ Studies show female, male and transgender sex workers face endemic 
violence from various perpetrators and at a range of different sites. 

□ In India, up to 35 percent of female sex workers face intimate partner 
violence; in Pakistan, up to 66 percent face physical violence and 34 
percent faced sexual violence; in China, 55 percent faced emotional 



5 Program on International Health and Human Rights, Harvard School of Public Health, 201 1 . Gender 
Based Violence and HIV. 

6 Decker MR, Seage GR 3rd, Hemenway D, et al., 2009. Intimate partner violence functions as both a 
risk marker and risk factor for women's HIV infection: findings from Indian husband-wife dyads. J Acquir 
Immune Defic Syndr 2009;51 (5):593-600 

7 However, the study did not conclusively establish whether the violence started with disclosure of 
HIV status or if the HIV was another trigger for violence. 

8 ChandrasekaranV, Krupp K, George R, Madhivanan P, etal. Determinants of domestic violence 
among women attending an Human Immunodeficiency Virus voluntary counseling and testing center 
in Bangalore, India. Indian J Med Sci 2007;61 (5):253-62. 

9 UNFPA, CASAM/APNSW, UNDP, Partners for Prevention, 201 2. Sex Work and Violence: Understanding 
Factors for Safety & Protection - Desk Review of literature from and about the Asia Pacific region. 



■ ■Sex workers' inability 
to enforce effective 
condom usage is a 
consequence of actual 
or threat of violence, 
regardless of who the 
perpetrator is. 

NEELANJANA MUKHIA, 
GUEST MODERATOR 



violence, 20 percent faced physical violence and 16 percent faced 
sexual violence 10 . 

□ In China, up to 70 percent of female sex workers face violence from 
clients; in India, up to 56 percent; in Cambodia, female and transgender 
sex workers are at particular risk of violence from gangs 11 . 

□ In Cambodia, freelance and brothel based female sex workers report 
physical and sexual violence, with the highest incidents reported by 
women in brothel-based sex work (75 percent physical and 57 percent 
sexual violence) 12 . 

Sex workers face violence from law enforcement authorities. Police 
surveillance can increase harassment and violence. 

□ In Fiji, police surveillance and the threat of criminal sanction affects sex 
workers 7 ability to safely negotiate condom usage with clients, thereby 
increasing their risk of HIV transmission 13 . 

Sex workers 7 inability to enforce effective condom usage is a consequence 
of actual or threat of violence, regardless of who the perpetrator is. 

□ In Thailand, sex workers who had experienced violence were twice 
as likely to report condom failure; in India, sex workers who report 
violence are less likely to have access to HIV prevention information and 



1 For more see, Shahmanesh, Maryam, V Patel, D Mabey & F Cowan, 2008. "Effectiveness of interven- 
tions for the prevention of HIV and other sexually transmitted infections in female sex workers in re- 
source poor setting: a systematic review.'Tropical Medicine and International Health Vol. 1 3 no. 5: 1 -21 ; 
Hawkes, Sarah & others, 2009. "HIV and other sexually transmitted infections among men, transgenders 
and women selling sex in two cities in Pakistan: a cross-sectional prevalence survey." Sexually Transmit- 
ted Infections, Vol. 85 Suppl. 2:8-1 6; Chen Zhang, Xiaoming Li, Yan Hong, Yiyun Chen, Wei Liu, Yuejiao 
Zhou, 201 2. "Partner Violence and HIV Risk Among Female Sex Workers in China." AIDS and Behavior, 
May;16(4):1 020-30. 

1 1 For more see Choi, Susanne YP, KL Chen, & ZQ Jiang, 2008. "Client-Perpetuated Violence and 
Condom Failure Among Female Sex Workers in Southwestern China." Sexually Transmitted Diseases Vol. 
35, no. 2: 141-146; Beattie,Tara SH & others, 2010. "Violence against female sex workers in Kamataka 
state, south India: impact on health, and reductions in violence following an intervention program." 
BMC Public Health Vol. 1 0: 476-577; Jenkins, Carol, The Cambodian Prostitutes' Union, Women's Network 
for Unity &Candice Sainsbury, 2006. "Violence and Exposure to HIV among Sex Workers in Phnom Penh, 
Cambodia." (Washington DC: The Policy Project, 2006) 

1 2 For more see Jenkins, Carol, The Cambodian Prostitutes' Union, Women's Network for Unity & Can- 
dice Sainsbury, 2006. "Violence and Exposure to HIV among Sex Workers in Phnom Penh, Cambodia." 
Washington DC: The Policy Project. 

1 3 For more see McMillan, Karen & Heather Worth, 2009. "Risky Business: Sex work and HIV preven- 
tion in Fiji." Sydney: International HIV Research Group, University of New South Wales; McMillan, Karen 
& Heather Worth, 201 1. "Sex Workers and HIV Prevention in Fiji - after the Fiji Crimes Decree." Sydney: 
International HIV Research Group, University of New South Wales. 



www.hivapcop.org 



enforce condom usage, and twice as likely to be infected with sexually 
transmitted infections 14 . 

Violence against women, girls and drug use 

□ Evidence on the risk of women who use drugs to HIV or violence is sorely 
lacking. Women who use drugs face conditions of marginalization, 
criminalization and police surveillance, which can increase their risk of 
violence. 

□ In many countries, possession of drugs or injecting equipment can 
lead to criminal sanctions, including imprisonment and involuntary 
detention in treatment centers, sites where women are at particular risk 
for violence 15 . 

□ During drug searches women are at particular risk for rape, sexual 
exploitation and sexual harassment and because possession of drugs is 
criminalized women are unable to report abuses for fear of retribution 16 . 



□ 



Even when perpetrators are not the police, women who use drugs are 
reluctant to report violence 17 . 



Violence against adolescent girls, young women and HIV 



□ 



Age disaggregated data collection has been very limited despite some 
evidence to show young women's vulnerability to violence and HIV. 

□ Globally, the majority of sexually active girls aged 1 5-1 9 in developing 
countries are married, and these married adolescent girls tend to have 
higher rates of HIV infection than their sexually active, unmarried 
peers 18 . 



14 For more see Beattie,Tara SH & others, 2010. "Violence against female sex workers in Kamataka 
state, south India: impact on health, and reductions in violence following an intervention program." 
BMC Public Health Vol. 1 0: 476-577; Swain, Suvakanta N & others, 201 1 . "Experience of violence and 
adverse reproductive health outcomes, HIV risks among mobile female sex workers in India." BMC Public 
Health Vol. 1 1:357-367; Decker, Michele& others, 2010. "Violence victimisation, sexual risk and sexually 
transmitted infection symptoms among female sex workers in Thailand." Sexually Transmitted Infections 
Vol. 86: 236-240. 

1 5 HAARP, 201 1 . Understanding and responding to gender issues in substance use in South-East Asia: 
an analytical review, AUSAID. 

16 Wolfe D, Saucier R., 2010. "In rehabilitation's name? Ending institutionalized cruelty and degrading 
treatment of people who use drugs." International Journal of Drug Policy, doi:1 0.1 01 6 

1 7 HAARP, 201 1 . Understanding and responding to gender issues in substance use in South-East Asia: 
an analytical review, AUSAID. 

1 8 Bruce, Judith and Shelley Clark, 2004. "The implications of early marriage for HIV/AIDS policy," brief 
based on background paper prepared for the WHO/UN FPA/Population Council Technical Consultation 
on Married Adolescents. 



■ ■ Work to address the 
intersections between 
HIV and experiences of 
violence is crucial in order 
to prevent gender-based 
violence and lower HIV 
prevalence across the 
region. 

STEPHANIE MIEDEMA, 
RESEARCH AND 
EVALUATION ANALYST, 
PARTNERS FOR 
PREVENTION 



Violence against women in humanitarian settings and HIV 

□ Evidence from the region on violence-against-women in conflict and post- 
conflict settings as well as its linkages to HIV risk is limited. 

It is a pleasure for me as the consultant engaged by the IATT to develop the 
Discussion Paper to launch this e-discussion. We would like to hear your views 
on the information that has been identified above, on any programmes in 
the region that have been implemented to address HIV-VAW linkages and on 
recommendations and next steps, including addressing gaps in research. 

Beginning today, this e-discussion will run for the duration of the 16 Days of 
Activism on Violence against Women, and be divided into two Parts: 

Part 1 (26 November - 4 December): We would like to hear your views on HIV 
and VAW linkages in the region. This can include comments on the findings from 
the research highlighted above, or your experiences working on the issues and/ 
or as a person impacted and affected by HIV. 

Part 2 (4 - 10 December): We would like to hear from you about policies and 
programmes that will need to be implemented to address the dual challenges 
of HIV and VAW, including existing best practices from the region or beyond and 
new initiatives. 

I look forward to your contributions and hope this dialogue will provide impetus 
to the work done in the region on addressing violence-against-women and HIV. 

Contributors 

The HIV-APCoP e-discussion received contributions, with thanks, from the 
following members. Contributions to the prior-held survey were anonymous. 

■ Leakhena Sieng, UNDP Cambodia 

□ Maria Nepel, PSMO/Gender focal point - UNAIDS, Papua New Guinea 

□ Neelanjana Mukhia 

□ Peterson Magoola, Programme Specialist, HIV and Gender, UNDP Papua 
New Guinea; Dr. Moale Kariko, Deputy Director, National AIDS Council 
Secretariat, Papuea New Guinea; and lone Lewis, Inaugural Professor of 
Counselling and Pyschotherapy, Head of School of Counselling, Australian 
College of Applied Psychology 

□ Revati Chawla, NPO HIV & Youth, United Nations Population Fund, Colombo, 
Sri Lanka 



www.hivapcop.org 



■ Sam Winter, University of Hong Kong 

□ Sangita Singh, HIV Programme Officer, HIV, Health and Development, UNDP 
APRC 

■ Silja Rajander, HIV Focal Point, UN Women in Cambodia 

□ Stephanie Miedema, Research and Evaluation Analyst, Partners for 
Prevention 

□ Susana Fried, Senior Gender Advisor, Bureau of Development Policy, HIV, 
Health and Development Practice, UNDP 



Summary of Responses 



There was widespread consensus among contributors that gender-based- 
violence (GBV), including violence-against-women, are issues of serious concern 
for the region. Stemming from a manifestation of unequal power relations 
between men and women, participants noted that traditional and cultural 
roles often perpetuate gender inequality and violence-against-women. It was 
also noted that much of the violence faced by women goes unreported. This 
may be a result of women being unaware of available services. While much has 
been done to put laws in place, one of the biggest challenges that remains is 
their implementation in providing equal access to justice, services and personal 
safety and well-being for those experiencing violence. For example, there 
are few legal, health and support services (in the context of HIV) available for 
survivors of violence in the region. 

Lack of evidence 

□ Many contributors expressed concern over the lack of evidence available on 
HIV and violence-against-women in the region. Without empirical evidence 
policy makers face challenges in developing and implementing policies 
and programmes that adequately address these linkages. Even when laws 
and policies do exist, there can sometimes be little effort made to actually 
implement them. For example, contribution from Papua New Guinea noted 
that there has been poor implementation of the HIV/AIDS Management and 
Prevention (HAMP) Act and the Family Law. 

□ Contributors noted that while there have been some attempts to collect 
data on VAW, including in instances of domestic rape, child sexual abuse 
etc., these surveys do not collect data on HIV linkages. Similarly, data on HIV 
also focuses narrowly on a person's behaviour and does not include their 



■ ■Violence against 
sex workers must be 
understood beyond the 
individual and within a 
context of widespread 
stigmatization of and 
discrimination against sex 
work and sex workers, 
which makes it difficult 
for sex workers to 
obtain protection from 
violence and to access 
support when they have 
experienced violence. 

SANGITA SINGH, HIV 
PROGRAMME OFFICER, 
HIV, HEALTH AND 
DEVELOPMENT, UNDP 
APRC 



qualitative experiences of violence and abuse, and therefore misses vital 
information that can be valuable for HIV prevention work. 

Further to this, a contribution from UNDP in regards to sex workers noted, 
"Violence against sex workers must be understood beyond the individual and 
within a context of widespread stigmatization of and discrimination against 
sex work and sex workers, which makes it difficult for sex workers to obtain 
protection from violence and to access support when they have experienced 
violence." A regional research project/Sex work and violence: Understanding 
factors for safety and protection 7 , is currently being conducted by UNDP, 
UNFPA, APNSW, CASAM, P4P and UNAIDS in Myanmar, Sri-Lanka, Indonesia 
and Nepal that looks at the intersection between HIV, sex work and violence. 
The study ai ms to, "better understand the risk and protective factors associated 
with sex workers' exposure to violence and HIV (during and outside of sex work) 
and to inform policy and programmes to prevent and respond effectively to 
violence against female, male and transgender sex workers" 19 

Research conducted has led to establishing HIV and VAW linkages and 
produced effective recommendations. For example, "Partners for Prevention 
is coordinating a regional multi-country study on men's perpetration of gender- 
based violence. The study, called "The Change Project"! 20 ], interviews men - 
and, in some sites, women as well - to explore men's use of violence and links 
to notions around masculinities. The study also looks at men's sexual health 
practices and sexual behavior patterns." Findings of the study, conducted 
across six countries in Asia-Pacific, "... point to a picture of women's limited 
ability to negotiate condom use, and vulnerability (of both women and men) 
to STIs and HIV. Both factors point toward partner relationships in which 
inequalities and power imbalances limit healthy sexual choices and equitable 
relationship dynamics. Work to address the intersections between HIV and 
experiences of violence is crucial in order to prevent gender-based violence 
and lower HIV prevalence across the region." A member from UNAIDS PNG 
highlighted findings from a study in that country 21 that demonstrated that 
women who report child sexual abuse were twice as likely to be HIV positive 
and seven times more likely to engage in transactional sex. This evidence 
has since led to development of national policies and strategic plans to 
respond to HIV and gender-based violence in PNG and other countries in 
Asia and the Pacific. 



1 9 A regional publication capturing the results of the study is to be released in 201 3. 

20 The results of the Change Project regional study will be launched in July 201 3. For more informa- 
tion on the study visit http://www.partners4prevention.org. 

21 Lewis et al. 2009. Final Report on Links between Violence against Women and the transmission of 
HIV in 4 provinces of Papua New Guinea, cited in the Commission on AIDS in the Pacific's 2009 report 
Turning the Tide: An OPEN Strategy for a response to AIDS in the Pacific. 



www.hivapcop.org 



Lack of services 

□ In PNG and Cambodia, assessments that have been done on HIV and VAW 
services demonstrate serious gaps in services for survivors of VAW and 
almost no services for sex-workers, transgender people or men who have 
sex with men. For example, studies called on the importance of the need 
to address the gap in services in providing post-exposure-prophylaxis for 
survivors of sexual violence. Studies in each country also found that HIV and 
VAW programmes were run in parallel with poor communication and referral 
mechanisms. Contributors echoed these sentiments, "HIV and Gender are 
seen as two separate and different problems. HIV is seen as a 'health' problem, 
while gender is seen as a 'social and cultural' problem. This kind of point of view 
influence the approach and methodology taken by the government into AIDS 
response." 

Key HIV affected populations face disproportionate violence 

□ Many contributors noted key HIV affected populations faced 
disproportionate violence, including female sex workers, transgender 
people and men who have sex with men. On violence faced by sex workers, 
a contribution from UN Women in Cambodia pointed out, "Rates of violence 
are particularly high among female sex workers and transgender women in 
Cambodia. Jenkins' 2006 study[22] on 500 freelance sex workers, of whom 14% 
were sray sros (transgender women), found that altogether 86.8% of female 
freelance sex workers had been raped in the past year, and this rate was higher 
at 90.8%) among the sray sros. Altogether 54.8%) of female sex workers and 
37.5%o of sray sros included in the study were gang raped by clients in the past 
year." 

Sam Winters from the University of Hong Kong highlighted the extent of 
violence confronting transgender men and women. Noting the magnitude 
of the problem, he stated that according to the Transmurder Monitoring 
Project's report 23 , between January 2008 and November 2012 a total of 
1,080 transgender people have met violent deaths. In Asia and the Pacific, 
20 were reported to have met violent deaths between November 201 1 and 
November 201 2. Transgender stigma has repercussions, which can "...push 
trans people out of the social, economic and legal margins, leading to poor 
physical and emotional well-being and involvement in risky situations and risky 
behaviour patterns, and thence to sickness." 



22 Jenkins, C. 2006. Violence and exposure to HIV among sex workers in Phnom Penh, Cambodia. The 
Policy Project, USAID. Accessible at http://www.hivpolicy.org/Library/HPP001 702.pdf 

23 Accessible at http://www.transrespect-transphobia.org/en_US/tvt-project/tmm-results/tdor201 2. 
htm 



A number of commentators referred to institutional violence and violence 
perpetrated by law enforcement agents, most notably the police. In this 
regard mis-use and abuse of laws by police officers to harass, ill-treat and 
physically and sexually abuse sex workers were reported. "Police officers 
treat them very badly, they use to drag their hair and hit by foot, use very bad 
words among the public. . . . Some police officers use to hit them till bleeding. . . 
sometimes FSWs have to provide sex while they are in the police." With 
Furthermore, Sam Winters commented, "Healthcare that is poorly matched 
to trans people's needs, delivered in a downright discriminatory fashion, or even 
withheld, aggravates health issues." 



■ ■Healthcare that 
is poorly matched to 
trans people's needs, 
delivered in a downright 
discriminatory fashion, or 
even withheld, aggravates 
health issues. 

SAM WINTER, UNIVERSITY 
OF HONG KONG 



Conclusions: 

The contributions received to this HIV-APCoP e-discussion on linkages between 
violence-against-women and HIV have been instrumental in shaping the 
recommendations list below, which will be incorporated into the Discussion 
Paper. 

Research agenda 

□ Sex and age disaggregated data collection, across targets and indicators 
covering all key populations, should be encouraged, resourced and fast 
tracked so as to ensure gender analysis is integral to all HIV plans. 

□ Data collection of indicators on the prevalence of intimate partner violence 
should be encouraged, resourced and fast tracked and should cover all 
women at particular risk of HIV, including but not limited to sex workers, 
transgender population, women living with HIV and women who use drugs. 

□ Collect data on availability and accessibility of female condoms to all 
women, including but not limited to, female sex workers, and women living 
with HIV, married women, women who use drugs and other at risk women. 

□ Research the diverse and complex linkages between violence against 
women and HIV in the context of systemic gender inequality, poverty, 
and multiple discriminations, including but not limited to, women's risk to 
violence and HIV in conflict, post-conflict and humanitarian settings; young 
women's risk to violence and HIV, including in the context of early marriage; 
specific risks and vulnerabilities of lesbian, bisexual and transgender 
women, migrant and undocumented migrant women, female prisoners, 
women with disabilities and women in serodiscordant relationships. 



10 



www.hivapcop.org 



□ Map all perpetrators of violence against sex workers and understand the full 
range of violence they face, as well as protection factors that interrupt their 
risk for violence and HIV. 

□ Conduct research on the role of criminalization, police surveillance, 
harassment and violence in increasing HIV risks of sex workers and women 
who use drugs, including in health systems, detention centers, rehabilitation 
centers, and their impact on access to justice, HIV and harm reduction 
services. 

□ Conduct research on the gender specific risks and vulnerabilities of women 
who use drugs, including their fear of disclosure and risk for violence, gate- 
keeping by others, and their sexual and reproductive needs and rights. 

□ Expand the evidence base on what works by evaluating and showcasing 
interventions that address gender equality, violence against women and 
HIV, including evaluating the appropriateness of successful interventions for 
replication and scale-up. For example, there are a number of sex worker led 
initiatives in the region that should be costed and modeled for replication 
or scale up. 

Advocacy agenda 

□ Laws, policies and practices that discriminate against women and people 
living with HIV, should be reformed in line with internationally agreed 
human rights standards. In particular, countries should legislate against 
all forms of violence against women, including but not limited to, intimate 
partner violence, marital rape and sexual harassment 

□ Laws, policies and practices that undermine and erode national AIDS 
responses, such as criminalization of same sex practices, sex work and drug 
use; possession of condoms and clean needles as evidence for criminal 
sanction should be reformed. 

□ State institutions such as health systems and law enforcement machineries 
should follow a zero tolerance policy to stigma, discrimination and rights 
violations, sexual harassment and violence, especially directed at women 
living with HIV, sex workers, women who use drugs, transgender people 
and men who have sex with men, and ensure equal access to justice to all. 

□ Laws and policies that guarantee women's sexual and reproductive rights 
and prevent and redress violence against women should be resourced and 
strengthened to respond to all women's dual risk of violence and HIV. In 
particular, policies that hinder access to sexual and reproductive health 



11 



■ ■ While we may not 
have all the evidence 
we need [in Cambodia], 
we clearly have enough 
to know that GBV is a 
critical issue to which 
HIV programs and 
interventions need to 
respond, and that these 
concerns and issues need 
to be integrated within 
and linked to broader 
programs and strategies 
that address GBV. 

SILJA RAJANDER, HIV 
FOCAL POINT, UN WOMEN 
IN CAMBODIA 



services and products to adolescent girls and unmarried women should be 
reformed. 

□ Greater coordination between line ministries should be prioritized and 
women's machineries should be resourced and strengthened, so that 
women's dual risk to violence and HIV is reduced. 

Interventions 

□ National HIV plans should integrate, cost resource, evaluate and scale up 
interventions that integrate gender inequality and violence against women. 

□ National violence against women plans should integrate HIV components 
so as to respond to women's risk for HIV. Also, these and other gender 
equality plans and services should be monitored to ensure accessibility for 
all women, including sex workers, women living with HIV, women who use 
drugs, and others who are marginalized and hard to reach. 

□ HIV prevention programmes for young people should integrate gender 
equality components and challenge violence against women. 

□ Programmes for sex workers should acknowledge and address the full 
range of violence faced by them; facilitate and resource collective action; 
and ensure state institutions are accountable for preventing and redressing 
violence against sex workers regardless of who the perpetrator is. 

□ Programmes for people who use drugs should respond to needs and risks 
of women who use drugs, including their access to integrated HIV, harm 
reduction, sexual and reproductive health and violence response services. 

□ Different models of enhanced voluntary counseling and testing services 
and the provision of comprehensive post-rape care services, and other 
integrated services should be evaluated and costed for scale up and 
replication. Services should be periodically monitored to ensure accessibility 
for all women, including sex workers, women living with HIV, women who 
use drugs, and others who are marginalized and hard to reach. 

□ All HIV interventions and services should monitor the gender specific 
barriers and human rights impacts of their activities and remedy any adverse 
human rights outcomes, including heightened risk for violence. 



This e-discussion, including all contributions in their entirety, can be accessed by 
visiting: 

http://www.hivapcop.org/e-discussion-linkages-between-violence-against- 
women-and-hiv-asia-and-pacific 



12 



www.hivapcop.org 



Resources cited in this e-discussion summary are availabie at the foliowing iinks 
as well as in the HIV-APCoP Resources Document Library: 

Beattie, Tara SH & others, (201 0). "Violence against female sex workers in Karnataka state, 
south India: impact on health, and reductions in violence following an intervention 
program." BMC Public Health Vol. 1 0: 476-577. 
http://www.ncbi.nlm.nih.gov/pubmed/20701791 

Bruce, Judith and Shelley Clark, (2004). "The implications of early marriage for HIV/AIDS 
policy," brief based on background paper prepared for the WHO/UNFPA/Population 
Council Technical Consultation on Married Adolescents. 
http://www.popcouncil.org/pdfs/CM.pdf 

Chandrasekaran V, Krupp K, George R, Madhivanan P, et al., (2007). "Determinants 
of domestic violence among women attending an Human Immunodeficiency Virus 
voluntary counseling and testing center in Bangalore, India." Indian J Med Sci;61(5):253- 
62. 
http://www.ncbi.nlm.nih.gov/pubmed/17478955 

Chen Zhang, Xiaoming Li, Yan Hong, Yiyun Chen, Wei Liu, Yuejiao Zhou, (201 2). "Partner 
Violence and HIV Risk Among Female Sex Workers in China." AIDS and Behavior, 
May;16(4):1 020-30. 
http://www.ncbi.nlm.nih.gov/pubmed/21598033 

Choi, Susanne YP, KL Chen, & ZQ Jiang, (2008). "Client-Perpetuated Violence and Condom 
Failure Among Female Sex Workers in Southwestern China."Sexually Transmitted Diseases 
Vol. 35, no. 2: 141-146; 
http://www.ncbi.nlm.nih.gOv/pubmed/1 7921 91 3 

Decker, Michele & others, (2010). "Violence victimisation, sexual risk and sexually 
transmitted infection symptoms among female sex workers in Thailand." Sexually 
Transmitted Infections Vol. 86: 236-240. 
http://www.ncbi.nlm.nih.gov/pubmed/20444745 

Decker MR, Seage GR 3rd, Hemenway D, et al., (2009). "Intimate partner violence functions 
as both a risk marker and risk factor for women's HIV infection: findings from Indian 
husband-wife dyads." J Acquir Immune Defic Syndr;51 (5):593-600. 
http://www.ncbi.nlm.nih.gOv/pubmed/1 9421 070 

HAARP, (2011). Understanding and responding to gender issues in substance use in 
South-East Asia: an analytical review, AUSAID. 

http://www.haarp-online.orq/LinkClick.aspx?fileticket=VHNUdJDPtSU%3D&tabid=2348 
&mid=4554 

Hawkes, Sarah & others, (2009). "HIV and other sexually transmitted infections among 
men, transgenders and women selling sex in two cities in Pakistan: a cross-sectional 
prevalence survey." Sexually Transmitted Infections, Vol. 85 Suppl. 2:8-16 
http://www.ncbi.nlm.nih.gov/pubmed/19307351 



13 



Jenkins, C. (2006). Violence and exposure to HIV among sex workers in Phnom Penh, 
Cambodia. The Policy Project, USAID. 

http://www.hivpolicv.orq/Librarv/HPP001702.pdf 

Lewis et al. (2009). Final Report on Links between Violence against Women and the 
transmission of HIV in 4 provinces of Papua New Guinea. 

McMillan, Karen & Heather Worth, (201 1). "Sex Workers and HIV Prevention in Fiji - after 
the Fiji Crimes Decree." Sydney: International HIV Research Group, University of New 
South Wales. 

http://sphcm.med.unsw.edu.au/sites/sphcm.cms.med.unsw.edu.au/files/sphcm/ 
Centres and Units/Fiji Crimes Decree.pdf 

McMillan, Karen & Heather Worth, (2009). "Risky Business: Sex work and HIV prevention in 
Fiji." Sydney: International HIV Research Group, University of New South Wales 
http://www.sphcm.med.unsw.edu.au/sites/sphcm.cms.med.unsw.edu.au/files/sphcm/ 
Centres and Units/Risky Business Fiji.pdf 

Report of the Secretary-General, (2006). 
http://www.un.org/womenwatch/daw/vaw/SGstudyvaw.htm 

Shahmanesh, Maryam, V Patel, D Mabey & F Cowan, (2008). "Effectiveness of interventions 
for the prevention of HIV and other sexually transmitted infections in female sex workers 
in resource poor setting: a systematic review." Tropica I Medicine and International Health 
Vol. 13 no. 5: 1-21 
http://www.ncbi.nlm.nih.gov/pubmed/18266784 

Swain, Suvakanta N & others, (201 1). "Experience of violence and adverse reproductive 
health outcomes, HIV risks among mobile female sex workers in India." BMC Public Health 
Vol. 11:357-367 
http://www.biomedcentral.com/1471-2458/11/357 

Transmurder Monitoring Project (2012) 

http://www.transrespect-transphobia.org/en US/tvt-project/tmm-results/tdor20 12.htm 

UNFPA, CASAM/APNSW, UNDP, Partners for Prevention, (2012). Sex Work and Violence: 
Understanding Factors for Safety & Protection - Desk Review of literature from and about 
the Asia Pacific region. 

Wolfe D, Saucier R., (2010). "In rehabilitation's name? Ending institutionalized cruelty 
and degrading treatment of people who use drugs." International Journal of Drug Policy, 
doi:10.1016 
http://www.iidp.orq/article/S0955-3959(10)00009-5/fulltext 



14 www.hivapcop.org 



How can the HIV-APCoP help you? 

Provide access to important publications, presentations, tools, and other materials. 

Provide access to emerging and good practices across the region. 

Provide information on upcoming events related to HIV, gender, and human rights in the region. 

Provide peer-review for your studies and guidance to resources under development. 

Link you to professionals working on issues related to HIV, gender, and human rights. 

Provide technical advice on specific queries. 

How can you contribute? 

• Share your organizations work on the HIV-APCoP through publications and best practices. 

• Post details of upcoming events relevant to HIV, gender and human rights in the region. 

• Respond to member's queries and share your expertise. 

• Participate in e-discussions. 

• Seek solutions to challenges encountered in work on issues associated wtih HIV, gender and 
human rights. 





U N 



D P 



Empowered lives. 
Resilient nations. 



United Nations Development Programme 
UNDP Asia-Pacific Regional Centre 

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Email: aprcth@undp.org 

Tel: +66 (0)2 304-91 00 

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